Search

Parallel to the frequent application of anterior segment surgical techniques, the frequency of dry eye disease is increasing. Dry eye is a multifactorial condition that affects the surface of the eye and induces an inflammatory response. Corneal nerves play an important role in the maintenance of a healthy ocular surface. Intact corneal innervation is mandatory for normal blinking and tearing reflexes. Damage to this neural circuit interrupts the normal regulation of lacrimal gland secretion and causes dry eye disease. Anterior segment surgeries damage corneal innervation. Even after a successful cataract or refractive surgery, the occurrence of dry eye leads to discomfort and several complications. Because of these problems, we have to know the risk factors and the triggering mechanisms of dry eye disease, to take precautions during and after the surgery, and to choose the appropriate surgical technique. [ABSTRACT FROM AUTHOR]

Femtosecond (Fs) lasers have ultra short laser pulses. Because of these short pulses the pulse energy is decreased and there is a reduction in the amount of thermal and mechanical damage to the surrounding tissues. Once designed to replace microkeratome in laser in-situ ker-atomileusis (LASIK), the Fs laser is being used and seems to be going to be used in many new areas. These areas are cutting flaps for LASIK, lenticule extraction for myopic correction, cuts for intrastromal ring segments, astigmatic keratotomy, lamellar keratoplasty, presbyopic correction, many steps in cataract surgery. In this review we will discuss recent advances about femtosecond laser. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to show at what rate the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected in practice and how up to date they are. Materials and Methods: A questionnaire conducted using SurveyMonkey was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in subgroups according to the participants' age, occupational status, institutions, and whether they conducted relevant academic activities, and the data were compared as inadequate, standard, and contemporary approaches according to the determined criteria. Results: Optical biometry devices were used at rates of 77.7% and 67.3% for intraocular lens (IOL) power calculations and keratometric measurements in preparation for cataract surgery, respectively. For IOL power calculation, third-generation formulas, especially the SRK-T, were used most commonly (46.2%), followed by second-generation formulas (21.9%), and fourth/fifth-generation formulas and multiple evaluations for different axial lengths (31.9%). The most common incision size was 2.8 mm (51.6%), while the percentage of 2.2 mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism was 18.8%. When selecting incision location, approaches to reduce corneal astigmatism were reported by 28.9%, neutral approaches by 26.2%, and insensitive approaches by 44.9%. Additionally, 55.6% of participants never implanted toric IOLs and 50.7% did not use presbyopia-correcting IOLs. The proportion of surgeons who have experience with femtosecond laser-assisted cataract surgery was 10.3% and the rate of intracameral antibiotic injection at the end of the operation was 89.4%. Conclusion: It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rates, but this was not reflected in practice at same rate in terms of achieving contemporary standards of refractive cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To determine the tear osmolarity changes in patients who had undergone phacoemulsification surgery. Material and Method: Tear osmolarity measurements were performed in 30 eyes of 30 patients who had undergone cataract surgery without any complication. Measurements were performed before surgery and consecutively at 1st month, 3rd month, and 6th month after the surgery. TearLab osmometer (TearLab Corporation, San Diego, CA, USA) device was used for the measurements and paired ttest was used for statistical analysis. Results: The mean age of the patients was 72.3±3.7 (67-78) years. Thirteen patients were men and 17 patients were women. The mean osmolarity values were 305.8±6.5 mOsm/L before the surgery and 312.3 ±6.4 mOsm/L at 1st month, 307.5±5.1 mOsm/L at 3rd month and 305.1±5.7 at 6th month after the surgery. The difference between the values before surgery and at 1st month was found statistically significant (p=0.001). Discussion: The tear osmolarity increases at the first month after surgery but decreases to the levels measured before surgery at the 3rd month. The increase at the first month may be due to the corneal incisions and medication used after the surgery. We think that we have to take into account this similarity increase in all cataract patients, especially in those who also have dry eye disease. [ABSTRACT FROM AUTHOR]

Apert syndrome is a rare seen congenital type 1 acrocephalosyndactyly characterized by craniosynostozis, syndactyly of the fingers and toes, dysmorphic facial features and ophthalmic abnormalities. In this case, we aimed to present ophthalmic abnormalities in a patient with Apert syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effects of topical loteprednol etabonate 0.5% and prednisolone acetate 1% on postoperative inflammation after cataract surgery. Materials and Methods: Forty eyes of 40 patients who underwent uncomplicated cataract surgery between October 2008 and February 2009 were included in this study. The patients were divided into two groups randomly; loteprednol etabonate 0.5% and prednisolone acetate 1% were used in group 1 and group 2, respectively. Preoperative and postoperative examinations were performed after 1 day, 1 week, and 1 month, and the anterior chamber cells, flare, best-corrected visual acuity (VA), and intraocular pressure (IOP) of the patients were compared statistically. Results: There were no statistically significant differences in mean VA or mean IOP measurements between the two groups at any postoperative visit. Although there were no significant differences in mean anterior chamber cells or flare of the patients between the two groups on postoperative day 1, mean anterior chamber cells and flare were significantly higher in group 1 than in group 2 at the first postoperative week (p=0.03, p=0.02). None of the patients had anterior chamber cells or flare at the first postoperative month in the groups. Fibrin reactions were observed in two patients in group 1 and gentamycine+dexamethasone were applied subconjunctivally for treatment. Conclusion: Loteprednol etabonate 0.5% is effective in controlling postoperative inflammation after cataract surgery, but less effective than prednisolone acetate 1%. Patients who receive loteprednol etabonate 0.5% treatment after uncomplicated cataract surgery must be followed up frequently. [ABSTRACT FROM AUTHOR]

Purpose: To compare a bupivacaine and lidocaine mixture with levobupivacaine and ropivacaine in terms of safety, efficacy and blocking quality in peribulbar anaesthesia for phacoemulsification. Methods: A total of 105 patients scheduled for cataract surgery with peribulbar anaesthesia were randomly allocated into three groups of 35 patients each, to receive 5 ml of, respectively, a 1 : 1 mixture of bupivacaine 0.5% and lidocaine 2% (group 1), levobupivacaine 0.75% (group 2), or ropivacaine 1% (group 3). Ocular movement scores were evaluated at 2, 4, 6, 8 and 10 mins after injection. Intraoperative and postoperative analgesia were evaluated by verbal pain scores. Duration of surgery, need for supplementary anaesthesia, haemodynamic parameters and the incidence of perioperative complications were recorded. Results: The ocular movement score in min 2 was significantly lower in group 1. There was no significant difference between groups 2 and 3. Ocular movement scores at mins 4 and 6 were significantly decreased in group 1 and 2 compared with group 3. There was no significant difference among the groups in ocular movement scores at mins 8 and 10. Verbal pain scores in postoperative hour 4 were highest in group 3, but scores for the intraoperative period and postoperative hours 1 and 2 were similar among the groups. Duration of surgery and haemodynamic parameters did not differ among the groups. Conclusions: All agents were considered to be convenient for clinical use in cataract surgery with peribulbar anaesthesia. Although the ocular movement scores in the ropivacaine group were higher than in the other groups at mins 4 and 6, this did not imply any clinical significance. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of brinzolamide 1%, brimonidine 0.2%, acetazolamide 250 mg, intracameral acetylcholine, and timolol 0.5% in preventing intraocular pressure (IOP) peaks during the early period after phacoemulsification in which sodium chondroitin sulfate 4%–sodium hyaluronate 3% (Viscoat) was used as the ophthalmic viscosurgical device (OVD). Setting: Department of Ophthalmology, Baskent University Medical Faculty, Ankara, Turkey. Methods: This prospective randomized study comprised 185 eyes of 185 patients with uncomplicated cataract scheduled for phacoemulsification using Viscoat as the OVD. Patients were randomly assigned to 1 of 6 groups: postoperative application of topical brinzolamide 1%, brimonidine 0.2%, oral acetazolamide 250 mg, intracameral acetylcholine, timolol 0.5%, or no ocular hypotensive agent (control group). The IOP was measured at baseline (preoperatively) as well as 6 hours, 20 to 24 hours, and 1 week after surgery. Results: The mean preoperative IOP values were not significantly different between the groups. Six hours and 20 to 24 hours postoperatively, the mean IOP was significantly lower in all groups receiving an ocular hypotensive agent than in the control group (P<.01). Six hours after surgery, the mean IOP significantly increased in all groups but was higher in the control group. At 20 to 24 hours, the mean IOP decreased significantly in all ocular hypotensive agent groups but remained significantly high in the control group. One week after surgery, there were no significant differences between the groups. Conclusion: Brinzolamide, brimonidine, acetazolamide, intracameral acetylcholine, and timolol had similar effects in reducing IOP increases after phacoemulsification performed using Viscoat. [Copyright &y& Elsevier]

Purpose: To compare 4 methods for intraoperative pupil dilatation in eyes with pseudoexfoliation syndrome and insufficient pupil size during phacoemulsification.Design: Prospective, randomized, comparative, interventional case series.Participants: Forty eyes of 40 patients with pseudoexfoliation and maximally dilated pupil size smaller than 3.5 mm.Intervention: Mechanical pupil dilatation with iris-retractor hooks (group I), polymethyl methacrylate (PMMA) pupil dilator-ring (Morcher, Stuttgart, Germany) (group II), Beehler pupil dilator (group III), and bimanual stretching (group IV).Main outcome measures: Performance (pupil size achieved), complications, and added surgical time.Results: The mean pupil sizes achieved with the PMMA pupil-dilator ring, Beehler pupil dilator, and bimanual stretching were 5.9±0.6 mm, 5.5±0.8 mm, and 4.9±0.7 mm, respectively. A square-shaped pupil was achieved with iris-retractor hooks, and the mean size of the largest circle that can fit in this square was 5.6±0.6 mm. There were no statistically significant differences in the postdilatation pupil sizes between the 4 study groups (P>0.05). Apart from self-limited intraoperative hemorrhage from pupil margin, iris sphincter rupture was the only observed complication related to mechanical pupil dilatation. This occurred in 4 eyes in groups I and III, 3 eyes in group IV, and 1 eye in group II (P>0.05). The mean added surgical time for placement of iris-retractor hooks and for implantation of a PMMA pupil-dilator ring was 297±51 and 176±54 seconds, respectively. The additional time required for pupil dilatation with the Beehler pupil dilator and bimanual stretching was 65±8 and 55±10 seconds, respectively. The time needed for pupil dilatation in groups I and II is significantly longer than that in groups III and IV (P<0.001).Conclusions: All 4 methods used in this study were effective procedures for the mechanical dilatation of small pupils secondary to pseudoexfoliation syndrome. Iris-retractor hooks and the PMMA pupil-dilator ring are the most time-consuming techniques but have the advantage of a stable pupil size throughout the surgery. The PMMA pupil-dilator ring causes the least iris trauma. The Beehler pupil dilator and bimanual stretching technique were the least time-consuming methods for mechanical pupil dilatation. [Copyright &y& Elsevier]